| NPI | 1699762716 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN196200) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: RI RN35392) |
| 363L00000X Nurse Practitioner (Licence: MA 196200) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2023-04-25 |